Chlamydia pneumoniae and coronary heart disease

OBJECTIVE: To review the potential association between Chlamydia pneumoniae (CP) infection and coronary artery disease (CAD), and to describe possible therapeutic interventions. DATA SOURCES: A MEDLINE search of literature (January 1966-January 1998) pertaining to CP infection associated with heart disease was performed. Additional literature was obtained from review of journals and reference lists of pertinent articles identified through the search. STUDY SELECTION AND DATA EXTRACTION: All articles involving CP and CAD were considered for possible inclusion in this review. Other selected articles involved possible links between infection and the atherosclerotic process, inflammation and inflammatory mediators in the atherosclerotic process, and isolation of CP from human tissue. DATA SYNTHESIS: Numerous reports have suggested an association between chronic CP and CAD. CP has been seroepidemiologically linked to CAD. The organism has also been isolated from atherosclerotic lesions. Two reports in humans and one report in animals have shown that macrolide therapy (azithromycin or roxithromycin) may decrease the risk of adverse cardiovascular events. CONCLUSIONS: Evidence seems to support an association between CP infection and an increased incidence of CAD. Additional and larger seroepidemiologic studies of this association need to be performed to establish a causal relationship between infection and CAD. Determination of the actual role of CP in CAD may decide the role of specific antichlamydial therapy in the management of this condition.

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